A 58-Year-Old Man Comes to the Office for Evaluation of a Foot

A 58-year-old man comes to the office for evaluation of a foot wound.  The patient noticed a small ulcer on the bottom of his right foot a week ago but recalls no significant foot injury.  He has been applying antiseptics, but the wound has failed to heal.  The patient has a 15-year history of type 2 diabetes mellitus and is nonadherent to medical therapy.  He has smoked a pack of cigarettes daily for 20 years.  Temperature is 37.1 C (98.8 F) , blood pressure is 140/80 mm Hg, and pulse is 72/min.  Right lower extremity examination shows a 1-cm (0.39-in) plantar ulcer under the first metatarsal head.  There are no other lesions, and the tibial and dorsalis pedis pulses are normal.  Which of the following is the major inciting factor responsible for this patient's foot ulcer?

A) Atherosclerotic disease
B) Bacterial infection
C) Irritant dermatitis
D) Sensory impairment
E) Systemic vasculitis
F) Venous insufficiency

Correct Answer:

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